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This article compares the efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) versus endoscopic retrograde cholangiopancreatography (ERCP) for primary drainage in patients with distal malignant biliary obstruction (DMBO). The study analyzed five randomized controlled trials involving 519 patients. The results showed that EUS-BD had a higher technical success rate and 1-year stent patency compared to ERCP, with similar clinical success rates and safety profiles. The authors suggest that EUS-BD could be considered as a first-line approach for DMBO due to its good performance. [Extracted from the article]

This article discusses the use of next-generation sequencing (NGS) as a tool for diagnosing genomic abnormalities in pancreatic cyst fluid. The study aimed to evaluate the feasibility and performance of NGS on pancreatic cyst fluid in a real-life setting. The researchers validated the DNA extraction technique and tested a panel of 91 genes by comparing the genomic abnormalities in the cyst fluid with those in histological samples. They then performed DNA extraction and NGS on pancreatic cyst fluids collected through endoscopic ultrasound (EUS). The results showed that NGS was concordant for 90% of the patients, and genomic abnormalities were detected in 20 out of 54 patients. The study concludes that NGS of pancreatic cystic fluid sampled by EUS is possible and effective, although genetic abnormalities were not detected in some patients. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the use of EUS-guided shear wave elastography (SWE) for the differential diagnosis of solid pancreatic lesions (SPLs). EUS elastography is a noninvasive technique that assesses tissue elasticity and has been useful for characterizing SPLs. However, the study found that EUS-SWE did not show significant differences in the velocity and elasticity values of different SPLs. Further research is needed to standardize the EUS-SWE procedure and determine its usefulness for characterizing and differentiating SPLs. [Extracted from the article]

The article presents abstracts related to endoscopic ultrasound (EUS) which includes the education on EUS in the U.S., the use of EUS with fine needle aspiration for staging of lung cancer, and the diagnosis of mediastinal node through EUS with traditional transbronchial needle aspiration.

With the increasing use of antiplatelet agents (APA), their management during the periendoscopic period has become a more common and more difficult problem. The increase in use is due to the availability of new drugs and the widespread use of drug-eluting coronary stents. Acute coronary syndromes can occur when APA therapy is withheld for noncardiovascular interventions. Guidelines about APA management during the periendoscopic period are traditionally based on assessments of the procedure-related risk of bleeding and the risk of thrombosis if APA are stopped. New data allow better assessment of these risks, of the necessary duration of APA discontinuation before endoscopy, of the use of alternative procedures (mostly for endoscopic retrograde cholangiopancreatography [ERCP]), and of endoscopic methods that can be used to prevent bleeding (following colonic polypectomy). This guideline makes graded, evidence-based, recommendations for the management of APA for all currently performed endoscopic procedures. A short summary and two Tables are included for quick reference. [ABSTRACT FROM AUTHOR]

Background and study aims: Distinguishing pancreatic adenocarcinoma from other pancreatic masses remains challenging with current imaging techniques. This prospective study aimed to evaluate the accuracy of a new procedure, imaging the microcirculation pattern of the pancreas by contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) with a new Olympus prototype echo endoscope. Patients and methods: 35 patients presenting with solid pancreatic lesions were prospectively enrolled. All patients had conventional B mode and power Doppler EUS. After an intravenous bolus injection of 2.4 ml of a second-generation ultrasound contrast agent (SonoVue) CEH-EUS was then performed with a new Olympus prototype echo endoscope (xGF-UCT 180). The microvascular pattern was compared with the final diagnosis based on the pathological examination of specimens from surgery or EUS-guided fine-needle aspiration (EUS-FNA) or on follow-up for at least 12 months. Results: The final diagnoses were: 18 adenocarcinomas, 9 neuroendocrine tumors, 7 chronic pancreatitis, and 1 stromal tumor. Power Doppler failed to display microcirculation, whereas harmonic imaging demonstrated it in all cases. Out of 18 lesions with a hypointense signal on CEH-EUS, 16 were adenocarcinomas. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of hypointensity for diagnosing pancreatic adenocarcinoma were 89 %, 88 %, 88 %, 89 %, and 88.5 %, compared with corresponding values of 72 %, 100 %, 77 %, 100 %, and 86 % for EUS-FNA. Of five adenocarcinomas with false-negative results at EUS-FNA, four had a hypointense echo signal at CEH-EUS. Conclusions: CEH-EUS with the new Olympus prototype device successfully visualizes the microvascular pattern in pancreatic solid lesions, and may be useful for distinguishing adenocarcinomas from other pancreatic masses. [ABSTRACT FROM AUTHOR]

The article presents the case of a 22-year-old white male presented to the emergency department complaining of left-flank pain and dark-colored urine. According to the patient, 3 days earlier he had taken some "bad falls" while practicing jujitsu and developed mild left-flank soreness. Six hours prior to presenting to the emergency department, he had attended a second jujitsu practice session during which he attempted to perform a throw on his opponent. The diagnosis of hematuria secondary to kidney contusion was made. A conservative treatment protocol was followed and the patient was discharged. The article says that students and martial artists should be taught about signs and dangers of kidney trauma and that sharp flank pain due to a fall is potentially serious.

Azathioprine hepatotoxicity has been described mainly in renal transplant recipients. Most reported cases are related to lesions of the venous system of the liver: peliosis hepatis, veno-occlusive disease of the liver, perisinusoidal fibrosis, and nodular regenerative hyperplasia of the liver. The most common clinical manifestation of these hepatic vascular lesions is portal hypertension. We present a case of nodular regenerative hyperplasia and perivenous fibrosis in a patient receiving azathioprine for multiple sclerosis. Histological abnormalities were similar to those described in renal transplant patients, and azathioprine was the only potential hepatotoxic agent present. [ABSTRACT FROM PUBLISHER]

The article presents a case study of a patient with colon adenocarcinoma who developed severe acute pancreatitis hours after undergoing endoscopic biopsy of the minor papilla of the duodenum. Topics discussed include abdominal pain reported by the patient, the results of computed tomography (CT) and magnetic resonance cholangiopancreatography, and liver metastasis.

A letter to the editor is presented in response to the article about a case control study of risk factors for hepatitis C infection by M. Karmochkine in the 2006 13 th issue.